Review Examines Treatment Options for Reflux in Idiopathic Pulmonary Fibrosis

Surgery may be an effective way to prevent reflux in individuals with idiopathic pulmonary fibrosis (IPF), according to a recent review.

The review authors found conflicting evidence on the ability of proton pump inhibitors (PPI) to improve IPF symptoms or disease progression. While several studies found positive results in patients taking PPIs, more recent studies have challenged these findings. Additionally, 3 clinical trials have suggested a possible link between lung infections and PPI use in patients with advanced IPF. The inconsistent results, according to the authors, could be attributed to the mechanisms of PPI, which only weakens the acidity of gastric contents rather than preventing reflux.
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According to the reviewers, better results have been reported in studies with patients who underwent laparoscopic anti-reflux surgery. The surgery reestablishes the competence of the lower esophageal sphincter and stops any type of reflux, which stabilizes the disease progression and improves overall survival.

“A phase II [National Institutes of Health] study in currently in progress in the USA to determine the role of antireflux surgery in patients with [gastroesophageal reflux disease] and IPF,” the researchers concluded. “The hope is that this simple operations might alter the natural history of IPF, avoiding progression and the need for lung transplantation.”

—Melissa Weiss

Reference:

Allaix ME, Rebecchi F, Morino M, Schlottmann F, and Patti MG. Gastroesophageal reflux and idiopathic pulmonary fibrosis [published online March 3, 2017]. World J Surg. doi:10.1007/s00268-017-3956-0.